Dealing With Insurance Denials

One of the most difficult tasks in the medical office for the billing department is to deal with insurance denials. Unfortunately many claims are rejected for various reasons and if not handled properly no payment will be made on that service. Most offices are extremely busy and it can be difficult to find the time to take care of these problems. If your office does not have the time and resources to take care of these denials, your receipts will suffer a lot.

Denials can note no coverage required for treatment. Each individual refusal needs to determine how you will get paid for that service date. Sometimes it will take only one phone call to fix the problem, but that phone call can take up to 45 minutes to get the preferred result. Some rebuttals will file revival of claim. An incorrect diagnostic code is an example of this. Some refusal may result in the patient being billed for the service but still have a 30-minute phone call to ensure that you are doing the right thing.

The secret to handling denial effectively is to act on denial as soon as possible. Many sections have a time limit that must be followed. Again, you need a good system to deal with denial. When a claim is denied, it works best for that problem and use the same method every time you deny it. Find the most effective solution to each denial and use that solution as soon as you receive the denial.

For example, when we receive a denial for medical records or treatment notes, we immediately type in a note and fax it to the providers office to let them know we need the record. Then we place the deny in the flap in front of the folder specified for that provider. As soon as the notes are sent to us we go to the folder of the provider and retrieve the denial. We print a new claim form and attach a copy of the denial and the note and note the recorded computer with that note.

Sometimes denial is completely wrong. Usually calling the insurance company can solve the problem. We sometimes have claims rejected at the edit level of electronic submission without insurance coverage. Calling the insurance company or occasionally checking their website can tell us that the prefix of the identification number has changed. We change the prefix and resubmit the claim. Or we might have created a typo in ID # that needs to be fixed.

We have claims that are accepted, but apply to the deductible. After the patient was billed, we received a call from the patient saying that they either did not have the deduction or had already received it. Sometimes the patient is wrong and sometimes the insurance company is wrong, but all these challenges must be dealt with if you want to get paid. The longer you delay dealing with problems, the better chance you will not be paid.